For quite some time academics have been predicting a severe nursing shortage in Canada and around the world. This was delayed because of the economic crisis of 2008 which caused many nurses to delay retirement and keep working. Unfortunately, our population has continued to get sicker and older and efforts to address the predicted shortage have fallen short. As a result we are now in the midst of the exact circumstances we were warned about: We don’t have enough registered nurses and those we do have are often working short-staffed and overtime. In some places it’s even become a challenge to schedule vacations because there just isn’t anyone to cover.
So how to solve the problem?
Option 1: Train more nurses. Considerations: nurses need full-time jobs when they graduate and governments and universities need to invest in nursing education (including hiring more educators for more students).
Option 2: Recruit nurses from other places. Considerations: Taking nurses away from places that also have a nursing shortage is unethical, not all nursing education is equal, and the process to get registered and licensed in Canada can take a couple years. In addition, bringing over foreign nurses to work below their scope of practice as personal care workers until they complete the process (if they can) is completely unethical.
Option 3: Let all nurses work to their full scope of practice (optimize use of health human resources). Considerations: In Northern and remote areas of Canada RNs are able to work to their full scope but in many hospitals and other health care organizations they work below their scope. For example, nurses have the expertise to assess wounds and make decisions about dressing changes but in some hospitals they need an order from a physician to make any changes. We are seeing LPNs (and RPNs in Ontario) starting to work more up to their full scope of practice which is great but all nurses should work to their full scope of practice. Appropriate staff mix is also essential (example: the ratio of RNs and LPNs should be different on different units).
Option 4: Health promotion and prevention (invest in public health and address social determinants of health). Heaven forbid we actually slow the flow of patients that need nursing care in the first place…but addressing the root causes of illness and disease would go a long way to decreasing use of the health care system in the long term.
Emily Read, PhD, RN 